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Last June, Robert Nichols of Waterville was playing a round of golf, just like he had done hundreds of times before. But something was different this time. When he got to the fifth hole, his chest began to hurt, and he just wasn’t feeling well. Robert was having a heart attack.

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Some Straight Talk about Ebola

10/21/2014

The Ebola Virus has been a hot topic of discussion in our country for weeks to months. I would like to start my contribution to the topic with what Ebola IS NOT.

Ebola is not a political issue. Ebola is not the apocalypse. Ebola is not a cause for mass hysteria in the United States.

Ebola is a potentially deadly virus that has killed thousands of people in three West African countries.

For the United States, with our considerable resources, this means being on the lookout for the needle in the haystack. IF – and it’s a big IF – more cases of Ebola infection are diagnosed in our country, we need to response quickly to successfully treat patients and prevent transmission to others.

The Ebola virus is a blood borne virus. It primarily infects animals such as fruit bats (not a concern in the US) and non-human primates such as monkeys and chimps. Ebola has never been seen in dogs or cats even in areas of epidemics. There is no evidence that it is carried by any insects either. Ebola can occur in humans when a “slipover” infection occurs from an animal source. Eating and or handling infected “bush game” are how this probably happened in West Africa. The Ebola virus can then be transferred between people.

The West African epidemic has been much worse than previous epidemics, probably for several reasons. It occurred in more urban areas than ever before, the families and facilities caring for patients had limited resources to protect against spread, and the customary ritual of washing the dead in these cultures increased opportunity for transmission.

Most people have heard that Ebola is spread through direct contact with fluids of infected persons. For many folks, it is probably not clear what that exactly means. Blood is obviously a fluid; so is sweat, saliva, snot (think cough/sneeze), poop, pee, semen, breast milk, and even tears. The infected fluid must come into contact with a “fluidy” part of another person to transmit infection. A break in the skin from a cut is an example. The mouth, nose, and eyes are other examples. Something simple such as absentmindedly rubbing an itchy eye with a hand that had touched infected fluid could transmit infection – hence the need for completely sealed hazmat type suits being used by providers. The infected fluids can be picked up from patients themselves, but also from items the fluids have contaminated such as bedding and clothes.

Unlike some other infections, Ebola is not contagious before an infected person has symptoms. Ebola is not transmitted by through the air either, as some infections (for example influenza) are. In short, it is not spread by casual distant exposure to strangers, despite the completely irrational action of the Maine Elementary school that banned a teacher just for being in Dallas, miles away from a patient.

Ebola infection can present with flu like illness or the more dangerous form of bleeding and organ failure. Symptoms usually occur 8-10 days after exposure but can be up to 21 days. Care of Ebola patients is “supportive” – meaning there is no specific medicine to “cure” the infection, rather the health care team tries to reinforce and support the person’s bodily functions until the infection runs its course. It goes without saying that the resources for “supportive” care in this country dwarf those in the epidemic regions.

Much has been made recently about preventing the possible influx of people with Ebola into the country. The airline industry is no stranger to passenger health concerns and there are pre-existing protocols for responding if passengers become ill or even die on route to the United States. The CDC has been actively and aggressively involved in modifying and optimizing these strategies during this Ebola epidemic. Currently, all prospective passengers from Ebola affected countries are screened. No one who is not well may board a plane to the US. Just today it was also announced that all passengers from epidemic areas can fly into only 1 of 5 airports in our country. Every passenger will continue to be monitored closely until the maximum incubation time has passed.
Managing information about the Ebola virus in a way that induces undo fear, or as a way to jostle for power does not honor those people who have died from it. That is my opinion as a provider of intensive care medicine. Rather, the gift to the rest of the world from the victims of this Ebola outbreak is one of knowledge and opportunity to prepare and combat further spread of this infection.